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Edith Cowan University
Research Online
Theses : Honours
1990
Nurses' Use Of Universal Precautions
Robin G.S. Jackson
Edith Cowan University
Recommended Citation
Jackson, R. G. (1990). Nurses' Use Of Universal Precautions. Retrieved from http://ro.ecu.edu.au/theses_hons/200
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WESTERN AUSTRALIAN COLLEGE
OF ADVANCED EDUCATION
Use of Theses
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the written pennission of the author to do so.
NURSES' USE OF UNIVERSAL PRECAUTIONS
BY
ROBIN G.S. JACKSON R.N.
A Thesis Submitted in Partial Fulfilment of the
Requirements for the Award of
Bachelor of Health Science (Nursing) Honours
Jt
the School of Nursing, Western Australian
College of Advanced Education.
Date of Submission : 21st May 1990
1
TABLE OF CONTENTS
l'aJl<'
ABSTRACT
3
DECLARATION
5
ACKNOWLEDGEMENTS
6
LIST OF TABLES
7
INTRODUCTION
8
Background and Purpose.
8
Problem Statement and Question for Study.
9
Definitions.
11
Specific Study Objectives.
!5
REVIEW OF LITERATURE
15
The Impact of AIDS on Cross Infection Policy.
!5
Concern of Society and Age Groups Involved.
17
Universal Precautions Versus Body Substance
!9
Isolation Technique.
~0
Relevant Studies.
METHODS
2!
Population and Sample
2!
Design and Instrument
,,
Data Collection
24
RESULTS
26
DISCUSSION
37
Recommendations
45
REFERENCES
46
APPENDIXES
2
ABSTRACT
Research into Acquired Immune Deficiency Syndrome, Hepatitis B., and other
bloodbome pathogens has led to the current worldwide awareness that patients can
be admitted to hospitals with potentially fatal diseases that can remain undetected in
blood and certain body fluids.
This has resulted in a change uf emphasis in
Infection Control, namely isolating the source of infection rather than isolating the
diagnosed infectious patient.
One such technique recommended to protect health
care workers, and other patients from nosocomial disease, is Universal Precautions.
This study, using a descriptive survey design and structured yucstionnairc examined
nurses' stated compliance to this technique in a suburban, non-teaching hospital of
over 100 beds. The 77 subjects, who volunteered to complete a questionnaire, were
all currently involved in direct patient care. Nursing staff working in the Gene1a\
Geriatric Ward, Psycho-Geriatric Ward, Gc.aeral Surgical/Medical Ward, Matcmity
Ward, and Operating Rooms were invited to take part in the study.
The
dclt:.~
collection took place over a one week period by the investigator personally taking
the questionnaires to the wards.
The analysis of the data. using a Statistical
Analysis System, showed that even though the level of knowledge and opinion Je,·el
were positive, the stated practice of Universal Precautions w:.ts low. The mngc of
correlations was so small that the planned multiple regression was only carried out
for one variable, knowledge, the result of which w:.ts F( l, 75)= l.3H. E<.24 .. which
was not significant.
The results of one-way analysis of variance computed for
stated pr<.!ctice by experience, level designation, and area of work were not
3
significant. This study revealed that though nurses may have a reasonable level of
knowledge, and a positive opinion towards Universal Precautions, the Stated
Practice may be low regardless of the years of experience, level of employment or
area of work. Research needs to be continued to further examine what other factors
may be influencing the lack of stated compliance by nurses 1 to Universal
Precautions, a recommended technique of nosocomial disease protection.
4
DECLARATION
"I certify that this thesis does not incorporate, without acknowledgement, any
material previously submitted for a degree or diploma in any institution of higher
education and that, to the best of my knowledge and belief, it does not contain any
material previously published or written by another person except where due
reference is made in the text".
5
ACKNOWLEDGEMENTS
Ruth C. MacKay, M.N., PhD., who as my supervisor gave valuable guidance and
support throughout the research project from proposal to completed thesis.
Amanda M. Blackmore BSc Hans who gave assistance with techniques of data
analysis and running of computerised statistic packages.
The Registered Nursing staff of Western Australian College of Ad,·qnccd Education
who completed questionnaires and gave informative feed-back.
The three Clinical Nurse Specialists who took time to assess the content validity of
the questionnaire.
The Research Nurse at the hospital participating in the study for her support of the
research project All the nursing staff of the hospital involved, who by volunteering
to fill in a questionnaire, made the data collection possible.
6
LIST OF TABLES
~
Tables
1.
Type of Nurse by Assumed Risk of Exposure.
"27
-·
0
Length of Clinical Experience by Assumed Risk of Exposure.
"28
3.
Mean, Standard Deviation, Range, and Scale Limits
"29
Pertaining to Nurses' Stated Practice, Opinion,
and Knowledge.
4.
Mean, Standard Deviation, and Range of Stated Practice Scores
30
by Nurse Level, Area, and Experience.
5.
Mean, Standard Deviation, and Range of Opinion Scores by
31
Nurse Level, Area. and Experience.
6.
Mean, Standard Deviation, and Range of Knowledge Scores
'O
o_
by Nurse Level, Area, and Experience.
7.
Correlation Matrix of Stated Practice, Opinion. and Knowledge.
33
8.
Significance of Variance in Stated Practice Accounted
34
for by Knowledge.
9.
One-way Analysis of Variance of Stated Practice by
Arc.:~..
10. One-way Analysis of Variance of Stated Practice by
35
35
Nurse Level.
11. One-way Analysis of Variance of Srated Practice by Experience.
7
36
!NTRODUCflON
Background and Purpose
During the last decade there has been a worldwide increase of incidence of
bloodborne viral infections.
The presence of Acquired Immune Deficiency
Syndrome (AIDS), Hepatitis B., and other bloodbome pathogens is now recognised
in most communities.
Research into such infections has led to the current
awareness that patients may be admitted to hospitals with a pmcmially fatal disease
that can remain undetected in blood and certain body fluids.
The condition commonly referred to as AIDS was first identified in the United
States in 1981. Since then cases have been reponed in all pans of the world. With
further study, AIDS was found to be caused by a virus, Human Immunodeficiency
Virus (HIV), that can remain undetected in blood and cerrain body fluids.
This
disease, combined with Hepatitis B and other bloodbome pathogens in health care
settings, has caused a change in cross infection policy throughout the world. One
impact has been on he::IIth care workers and methods to prevent nosocomial
(hospital acquired) disease.
The result has been the development of Universal
Precautions or Universal Blood and Bodv Fluid Precautions and Bodv Substance
'
Isulation.
8
The policy change in cross infection has resulted in a shift of cmphusis in cross
infection control, which is to isolate the source of the infection rather than relying
on a diagnosis and isolating the infectious patient. The potential source of infection
in bloodbome infections is blood and certain body fluids.
To isolate these
substances in all patients is known as Universal Precautions.
The situation exists that patients with undiagnosed, potentially fatal infections can
be admitted to hospital creating a health hazard to health care workers and other
patients.
The purpose of this study is to examine to what degree nurses follow
recommended techniques of preventing cross infection.
Problem Statement and Question for
Stud~·
The incidence of bloodboroe infections, particularly AIDS. is increasing in the
community. The World Health Organisation predicts that by the end of the 1990s
the number of AIDS cases will rise to six million (Nornhold, 1990). Though most
new cases will be in the Third World countries, other countries will correspondingly
experience an increase of AIDS cases. It therefore follows that the percentage of
patients admitted to hospital with undiagnosed potentially fatal diseases will also
increase. Logically the risk factor to health care providers must increase with the
increasing incidence within the community. Though the risk to health care workers
is considered to be small it does exist as a personal health hazard. In Sydney three
doctors and three nurses have been placed on a course of the antiviral drug AZT
following "significant exposure" to HIV positive body substances from infected
9
patients while at work. The Royal Prince Alfred Hospital in Sydney has recently
introduced a policy of offering prophylactic AZT to all staff who have experienced
"significant exposure" to r-UV within 7'2 hours of exposure.
AZT is a very
expensive drug, a six week course costs $1043, and though its effect on slowing
down, and perhaps preventing Aids is shown in animal experiments, there is no
conclusion about its effectiveness in human beings (Hicks, 1990). The risk exists,
and the fact that a hospital has offered AZT to its staff, in this manner,
demonstrates the level of concern by authorities in one hospital in Australia.
Most hospitals provide Hepatitis B vaccination for nurses as part of the staff
protection polices, but to date there is no vaccine available for protection against
other bloodbome pathogens such as AIDS. The lack of proof of the effectiveness.
and the expense involved. rules out the possibility of using AZT as a prophylactic
drug to protect health care workers from AIDS.
Nurses are at times exposed to patients' blood and body fluids and it is not
practical, nor is it possible to screen all patients for bloodbome infections prior to
admission to hospital. Though some health care workers arc of the opinion that it is
essential for hospital staff to know the
Hrv status of the patiem. for reasons of
ethics, protection of people's privacy, and to prevent discrimination, mandatory
screening of patients is not recommended by AIDS policy advisors (Al.DS
prevention and control, 1988). In regard to accident and emergency admissions it is
not possible to ascertain the HIV status of the patient prior to admission. At present
10
the tests that are available to establish HIV status can, for various reasons, give a
false positive or false negative result.
The only remaining means of protecting hospital staff against potentially fatal
diseases is the use of recommended cross infection polices, to isolate the source of
infection.
It is therefore important to examine to what degree nurses follow the
recommended cross infection policy change of isolating blood and certain body
fluids of all patients.
As part of the worldwide movement to promote safety amongst health professionals,
the hospital participating in the study, over a year ago, introduced Universal
Precautions.
This study was undertaken to ascertain the stated compliance of
nurses, involved in direct patient contact m most urcas of the hospital. to the
principles of Universal Precautions.
Specifically the following research question was posed: What is the lc\'cl of nurses'
stated practice to Universal Precaution principles?
Definitions
The tenns Universal Precautions and Body Substance Isolation arc often used
interchangeably which can be confusing.
Under
Univ~rsal
Precautions, blood and
certain body fluids of all patients are considered potentially infectious.
Body
Substance Isolation considers all moist body substances of all patients as potentially
11
infectious.
lbe Centres for Disease Control (C.D.C.) 1 Atlanta 1 Georgia made the following
recommendations for Universal Precautions (Cook 1988):-
Body Fluids to Which Universal Precautions Apply
blood
semen
vaginal secretions
tissues
cerebrospinal fluid
synovial fluid
pleural fluid
peritoneal fluid
pericardia! fluid
amniotic fluid, and
other body fluids containing visible blood
Body Fluids to Which Universal Precautions Do Not Apply
faeces
nasal secretions
sputum
sweat
12
tears
urine
vomitus
The concept of Body Substance Isolation can be described as:Body Substance Isolation
body fluids
body tissues
excreta
Hospitals have developed their cross
irifection
policies
between
Universal
Precautions, as recommended by the C.D.C., and the total coverage of Body
Substance Isolation.
For the purpose of this study, Universal Precautions shall be defined as describeJ
by the hospital involved in the study. That is. to add faeces and urine to the CDC
list of body fluids to which Universal Precautions apply.
Body Fluids to Which Universal Precautions Apply:
blood
faeces
urine
vaginal secretions
semen
13
.. •'
_
...•. ···
body tissue
cerebrospinal fluid
synovial fluid
pleural fluid
peritoneal fluid
pericardia! fluid
amniotic fluids
other body fluids containing blood
The major variables studied were knowledge of Universal Precautions, opinion of
cross infection principles, hospital area of work, length of experience, level
designation, and stated practice.
Definitions of Major Variables
Independent:
1.
Knowledge
what
nurses
know
about
Uni\'ersal
Precautions based on the Hospital's policy on infection
control.
2.
Opinion - what nurses believe/think about cross infection
principles.
3.
Area of work -
high, moderate, and low risk area
according to the assumed exposure risk level of the unit
the nurse is working in currently.
4.
Experience - how long the nurse has been involved m
direct patient care.
14
5.
Level designation - current level of employment category
of position held.
Dependent:
Stated practice -
the nurse's stated action in carrying out
Universal Precautions.
Specific Study Objectives
The specific study objectives were to determinc:1.
If practice as stated by nurses reflects Universal Precaution principles;
2.
The effects of knowledge on stated practice;
3.
The effect of opinion on stated practice;
4.
The effect of the area of work on stated practice;
5.
The effect of experience on stated practice.
6.
The effect of level designation on stated practice.
REVIEW OF LITERATURE
The Impact of AIDS on Cross Infection
Folic~·
Since the identification of AIDS, various means of communication have been used
to distribute information about the disease.
written on all aspects of the condition.
the history and spread of AIDS.
Included in this have been books
Often included in the books is a section on
One editor covers this under the heading
'Development of the Epidemic' (Alder 1988), which is how most authors view the
15
AIDS phenomenon. In fact some have likened it to a 20th century outbreak of the
"black plague".
A point made by Brass and Gold (1985) is that de;1Jite the discovery of the
causative virus little else is really known about AIDS as a disease process,
including detailed knowledge on aspects of the transmission from one person to
another.
There is now no known cure, and discussion in the literature includes
means of self protection against the infection such as safe sex practices and once
only use of sterile needles by intravenous drug users (Adler, 1988; Brass and Gold,
1985; Connor and Kingman, 1988).
In regard to transmission of the disease to
health care workers, or other patients, little is written in books.
Connor and
Kingman (1988) say "Health-care workers do, of course. have to take special care
when handling blood which may be infectious" (p. 13).
Brass and Gold (1985)
make the point that "The evidence on health workers catching the virus is still very
contradictory" (p. 144), but later state "To be as secure as possible, any health
workers who have contact in their work with members of the general public should
take extra care not to expose themselves to potentially virus-carrying body fluids"
(p. 145).
So in the literature on AIDS, where is the evidence that it
the AIDS epidemic that led to the
d~velopment
w;.~s
indeed the :..ld\'cnt of
of Universal Precautions as a
recommended method of protecting health care workers? This development is so
recent that at present written evidence is found only in Government Policy
16
Publications and Journal Articles.
The impact that identification of AIDS, and the discovery of its causative virus,
HIV, have had on isolation nursing and cross infection techniques, can best be seen
in the following quote from Morbidity and Mortality Weekly Report (1988):
"In 1983, CDC published a document entitled 'Guideline for
Isolation Precautions in Hospitals' ...The recommendations in this
section called for blood and body fluid precautions when a
patient was known or suspected to be infected with bloodbornc
pathogens. In August 1987, CDC published a document entitled
'Recommendations for Prevention of HIV Transmission in
Health-Care Settings'. In contrast to the 1983 document the
1987 document recommended that blood and bodv fluids
prccaurions be consistently used for all patients regardless of
their bloodborne infection status. This extension of blood and
body fluid precautions to ALL patients is referred to as
'Universal Blood and Body Fluid Precautions' or 'Universal
Precautions'. Under Universal Precautions, blood and certain
body fluids of all patients arc considered potentially infectious
for Human Immunodeficiency Virus (HlV), Hepatitis B Virus
(HBV), and other bloodbomc pathogens." (p. 36)
Up until this time only known infectious patients had been nursed with special
precautions such as isolation nursing. It is now recognised that it is the unknown
infection the patient may have that is the potemial hazard. What infection control
experts are now saying is that all patients should be viewed as potentially
infectious.
Concern of Society and Age Groups Involved
A measure of concern by society about this condition can be judged by the fact that
17
most western governments have published updated information and policies in
regard to all aspects of AIDS. In Australia such papers support the CDC Universal
Precautions as a means of infection control. Aids: A Time to Care, A Time to Act
(1988), National HIVIAIDS
Strate~y
(1989).
A high exposure to blood and body fluids not only occurs for health care workers in
Operating Rooms and Accident and Emergency Departments, but also in Delivery
Suites and Maternity units. Heterosexual spread of AIDS
to women is
and most women who are infected arc of child bearing age.
increasing,
Fckety (1989), a
midwife, states: "As the epidemic expands worldwide. greater proportions of our
clients will be at risk, and the heterosexually infected women and pcrinatully
infected baby will be encounted with increasing frequency until the spread of the
disease can be curtailed" (p. 257). According to Zeidenstein (1989), the reality of
AIDS is also causing a return to midwives using gowns. glasses, masks and gloves.
a practice that many discarded in the 1960s - 1970s.
At the other end of the age scale. health care workers involved in
gerontologic~:ll
nursing are beginning to become aware that older adults may be HIV positive, and
be infected with AIDS.
At present little is known about AIDS infection in the
elderly. The CDC weekly surveillance reports group all people over the age of -1-9
together, so there is no way of knowing the incidence of AIDS in people over 65
(Whipple, 1989).
18
Not all peop!e who are HIV positive present with the signs and symptoms of AIDS.
People who are HIV positive have an increased incidence of neurological
abnormalities and it is possible that people who are diagnosed as having dementia,
organic brain syndrome, or Alzheimer's disease may be HIV infected (Mirra,
Anand, and Spira, cited in Whipple, !989).
It is becoming increasingly apparent that health care workers have need for some
form of self protection when providing care for others, regardless of the age of the
patient.
Universal Precautions Versus Body Substance Isolation Techniques
The concept of Body Substance Isolation was proposed by Lynch, Jackson,
Cummings, and Stamm (1987).
This consisted of the usc of barrier precautions
(gloves, plastic aprons etc) when health care workers arc exposed to the pmient's
moist body substances, mucous membranes. and non intact skin.
Hollik ( 1989) in
comparing this to Universal Precautions says this method "emphasizes protection of
patient to patient cross infection in addition to protection of the employee", but
further states:- "Strict adherence to Body Substance Isolation, m many respects
represents an overkill approach to Infection Control" (p 77).
!9
Relevant Studies
One criticism of both Universal Precautions and Body Substance Isolation
techniques has been that in an emergency situation, staff don't have time to put on
protective gloves and aprons. Kelen, Di Giovanna, Bisson, Kalainov, Sivertson, and
Quinn (1989) in a study involving an emergency department, found health providers
followed Universal Precautions during 44% of interventions.
profuse bleedings, adherence fell to 19.5%
In patients with
The most common reasons given by
providers for not following precautions were insufficient time to pur on protective
attire and interference with procedural skills.
AnOlher study done by Baroff and Talan (1939), also in an emergency department,
concluded that there is currently a low rate of compliance with Universal
Precautions polices by emergency department personnel.
Another comment has been made that some staff go from patient to patient using
For the present though it remains a fact
the same pair of gloves (Yalemi, 1988).
that health-care workers and other paticms require protection from nosocomial
disease and the use of Universal Precautions or Body Substance Isolation is the
most effective way to date.
The literature reviewed establishes that bloodbome infections arc a worldwide
problem, and the AIDS epidemic is in progress.
Regardless of the age of the
patient or area of work health care workers need to be aware of the resulting
20
changes in cross infection policy and need to take care in protecting themselves by
implementing recommended methods of Universal Precautions.
The development
and rationale for the use of Universal Precautions is well supported, but evidence of
the actual use of Universal Precautions is lacking, other than the low standard of
use in emergency departments.
METHODS
Po_pu\atjon and Sample
The popu:ation for the pilot study was Registered Nurses currently employed by the
School of Nursing at the Western Australian College of Advanced Education. The
10 who volunteered to take part in the pilot study were all currently involved in
clinical practice in similar areas as the areas used in the study.
The population was the nursing staff employed at a suburban, non-teaching hospital
of over 100 beds in Perth. Wc.,Lern Australia. All nursing staff working at the time
of the ciata collection were invited to take part.
nurses from
the
General Geriatric Ward.
The study sample consisted of
Psvcho Geriatric Ward, General
Surgical/Medical Ward, Maternity Ward and Operating Rooms.
All full-time and permanent part-time nurses involved in direct 'hands-on' delivery
of care, and not on leave, were invited to take part in the study. This included all
Registered Nurses from level one, all Clinical NurSes from levels two and three, and
21
all Enrolled Nurses. Agency and casual part-time staff were not included.
Design and Instrumentation
A descriptive survey design was used m this study, and data were collected by
means of a structured questionnaire.
The questionnaire (Appendix A) was used in this study as a means to measure three
of the v.:rriables, stated practice, opinion about cross infection principles and
knowledge about Universal Precautions. The data for the remaining three variables,
area of work, experience and level designation were obtained from the demographic
data form (Appendix B).
A search of the Medline data base, forward from 1984, and books which list
instruments used in nursing research, failed to find a suitable tool for data
collection. The only tool was mentioned in an abstract of a conference repon. This
was subsequently obtained from Docken. one of the authors.
The instrument designed by Docken. Beiningcn. and Vander Woude (1989) was
developed to monitor compliance with Body Substance Isolation. following its
implementation in a 499-bed acute care hospital. The instrument they US1!d covered
three sections, practices, opinion, and knowledge. They detem1ined it was better ro
ascertain the compliance of their personnel based not only on stated practices, but
also on opinion and knowledge of the Body Substance Isolation policy. They further
stated that observational monitoring is difficult, in thut individual judgement and
22
skills in this area cannot be evaluated by simply observing. Also practices may be
skewed, they stated, because of the presence of observers. The instrument used in
this study was drawn from the instrument they used.
The concept of using the three sections, stated practice, opinion, and knowledge,
was retained. The format of stated practice was changed to a scenario with a choice
of stated action. Opinion was changed to a bi-polar graphic scale. Multi-choice
knowledge
questions
were
checked against
the
literature
ubout
Univcrsul
Precautions as defined by the hospital used m the studv. Adjustments were then
made accordingly.
To establish the level of content validity. a validity assessment by three content
specialists was carried out as described by Waltz. Strickland, and Lcnz ( 19H3. p.
196). They state an index of +1.00 will occur when perfect positive item-objective
congruence exists, that is, when content specialists assign a +1 to the item for its
relevance to the stated objective, and a -1 ro those items which do not fit the
objective.
Three content specialists rated items on the objective set. The items tested were aU
the questions from the stared practice and knowledge sections of the questionnaire.
All stated practice questions, except number seven, had an index of item-objective
congruence of +1.00.
One content specialist disqualified herself from rating
question seven concerning a specialised area of practice outside of her experience.
The remaining two content specialists gave question seven an index of item-
23
objective congruence of +1.00. All knowledge questions had an index of itemobjective congruence of +1.00.
The content of the questionnaire was therefore
accepted as valid.
To trial the questionnaire a pilot study wao,; carried out to determine. the clarity of
the questions, effectiveness of instructions, completeness of response sets, and the
time required to complete the questionnaire. Comments made by participants in the
pilot study resulted in the addition of a hand washing choice in the stated practice
section, and in the knowledge section the change of wording in one multiple choice
question, and the changing of an answer in one multiple choice response. These
minor adjustments were made to the questionnaire before the data collection
commenced.
Data Collectjon
The data collection took place over a one-week period. The investigator personally
took the questionnaires to the areas.
To protect human rights the investigator gave the subjects verbal information and a
written explanation was attached to each questionnaire (Appendix C).
Subjects
were infonned that to protect their identity no names would be recorded, and no
record was kept of the day, the time, or the group from which the questionnaires
came. Consent was assumed by subjects volunteering to return a questionnaire. and
the subjects were informed that they would not be discriminated against for not
24
being involved, and that they could withdraw from the study at any time.
Also the subjects were informed of the purpose and use of the collected data, and
that the results of the study would be presented to the hospital and participants after
completion of the study.
Slit top boxes were provided for subjects to place the completed questionnaires in,
and the investigator collected the boxes each Jay.
On the first day the two Geriatric Wards were visited at handovcr time when both
the day and evening staff were present. The same format was used the second day
for the Maternity and General Medical and Surgical Wards. The areas were visited
in the same way every second day during the week, three times in aH. The sw.ff
from the Operating Rooms were invited to take part on one day only :md all staff
not on leave were present that day. On two alternative nights the nightstaff in ;:Ill
four wards were invited to participate. Of the 100 questionnaires distributed 77 were
completed and returned. This represented a 77% return.
Methodological limitations occur in usmg a questionnaire to assess stated
compliance.
With the use of a questionnaire the problem exists in assuming
practice on the basis of stated behaviours, and it is assumed that participants
honestly state their practice.
To assess compliance direct observations :ue often
used, but due to time restraints and complexities involved in using observations this
25
was not possible in this study. To help establish the level of instrument reliability it
was intended to use Cronbach 1s coefficient alpha to test for homogeneity of internal
consistency for each of the scales in the instrument. Unfortunately the programme
was not available to be used.
It is recommended that this be done prior to the
instrument being used in future studies.
It was not possible to a!:sess concurrent validity because no other instrument was
available for comparison.
RESULTS
At completion of the data collection the data were coded prior to analysis using the
Statistical Analysis System (SAS).
The level of significance was set at .05 for
hypotheses testing.
The level designation of the subjects was divided into three levels.
Level A
Enrolled Nurses
Level B
Registered Nurses currently employed as a Level 1
Level C
Registered Nurses currently employed as a Level 2 or 3.
The area of work was divided into three categories according to the assumed risk
level of nurses being exposed to splashing, or spraying, with patients 1 blood or body
fluids.
26
Area 1
high risk - operating rooms and maternity ward (included
delivery suite).
Area 2
moderate risk - general surgical and medical wards.
Area 3
low risk - general geriatric and psycho geriatric wards.
Details of the sample numbers in each area of assumed risk and type of nurse are
displayed in Table 1.
The sample details of the area of assumed risk and
experience are displayed in Table '2.
Table 1
I~·pe
of Nurse by Assumed Risk of Exposure
Level
Area 1
Area '2
Area 3
TOTAL
Level A
3
4
12
19
Level B
10
8
12
30
Level C
9
7
12
28
19
36
77
TOTAL
27
Table 2
Length of Clinical Experience by Assumed Risk of Exposure
Experience
N
Area 1
Area 2
Area 3
Under 6 months
1
0
1
0
6 months to < 1 year
1
0
1
0
1 to < 3 years
3
1
I
1
3 to < 5 years
7
1
,
4
5 to < 10 years
11
3
3
5
10 to < 15 years
18
8
3
5
15 to < 20 years
13
,
,
-
9
20 years and over
23
7
6
10
The mean, standard deviation, and range were calculated for the variables: stated
practice, opinion and knowledge given in Table 3. This showed the level of stated
practice to be low, having a mean score of 1.04 out of a maximum possible score of
7. Opinion and knowledge were of a reasonable level, opinion having a mean score
of 43.57 out of a possible maximum score of 60, knowledge 6.97 out of a
maximum possible score of 10.
28
Table 3
Mean. Standard Deviation. Range and Scale Limits Pertaining to Nurses' Stated
Practice. Opinion and Knowledge
Variable
Stated Practice
Opinion
Knowledge
M
SD
Actual Range
Scale I .imits
of Scores
of Scores
1.04
1.14
0-4
0-7
43.57
5.50
28-57
10-60
6.97
1.64
2-9
0-10
State:i practice, opinion. and knowledge scores. m relation
to
the
nurses'
characteristics of level designation, area of work. and length of experience. arc
given in Tables 4, 5, and 6.
29
Table 4
Mean, Standard Devjatjoo. and Range of Stated Practice Scores by Nurse I&Yd
Area and Experience
Variable
N
M
SD
Range
Level A
19
1
1.20
0-4
Level B
30
1.03
1.13
0-4
Level C
28
1.07
1.15
0-4
Area 1
00
1.09
l.l9
0-4
Area 2
19
1.00
1.00
0-3
Area 3
36
1.02
1.20
0-4
Under 6 months
1
0
0
-0
6 months to < 1 year
1
0
0
0
1 to< 3 years
3
.3
.5
0-1
3 to < 5 years
7
1.71
1.60
0-4
5 to < 10 years
11
1.27
1.27
0-4
10 to < 15 years
18
0.94
1.11
0-3
15 to < 20 years
13
1.15
0.99
0-3
20 years and over
23
0.91
1.08
0-4
30
Table 5
Mean, Standard Deviation, and Range of Opinion Scores by Nurse Level. Area. and
Experience
Variable
N
M
SD
Range
Level A
19
43.74
4.16
35-50
Level B
30
43.43
6.15
28-54
Level C
28
43.61
5.75
30-57
Area 1
00
44.82
6.24
30-57
Area:!
19
43.21
6.35
31-54
Area 3
36
43.00
+.50
28-49
Under 6 months
1
5+.00
0
54
6 months to < year
1
+3.00
0
+3
1 to< 3
3
+5.00
5.57
+0-51
3 to < 5 years
7
39.1+
5.1+
35-49
5 to < 10 years
ll
+5.36
3.32
42-51
10 to < 15 years
18
+3.88
7.19
30-57
15 to < 20 years
13
++.31
5.63
28-50
20 years and over
23
+2.78
4.25
35-+9
31
Table 6
Mean, Standard Deviation, and Range of Knowledge Scores by Nun;e L&vel, Area,
and Experience
Variable
N
Level A
19
Level B
SD
Range
6.42
1.71
2-8
30
7.30
!.56
3-9
Level C
28
7.00
1.63
3-9
Area 1
22
6.95
1.49
4-9
Area 2
19
7.49
J.6g
2-9
Area 3
36
6.72
1.68
3-9
Under 6 months
1
54.00
0
54
6 months to < 1 year
1
43.00
0
43
1 to< 3 years
3
45.00
5.57
40-51
3 to< 5 years
7
39.14
5.14
35-49
5 to < 10 years
11
45.36
3.32
42-51
10 to < 15 years
18
43.88
7.19
30-57
15 to < 20 years
l3
4>1.31
5.63
28-50
20 years and over
23
42.78
4.25
35-49
M
32
The degree to which knowledge, opinion, and stated practice arc associated was
computed through simple correlations and is reported in Table 7. The correlations
were small and not significant.
In order to know the impact of the variables,
knowledge and opinion, on stated practice, forward multiple regression was
computed. Knowledge having the higher correlation was used first, to be followed
by opinion. The result was £(1,75) = 1.38, p<.24, which was not significant, shown
in Table 8.
With this result the multiple regression ceased and opinion was nm
computed.
Table 7
Correlation Matrix of Stated Practice. Opinion and Koow!eJge
Variable
Opinion
Knowledge
Stated Practice
0.053
0.134
0.222
Opinion
33
Table 8
Significance of Variance in Stated Practice Accounted for by Knowledge
Variable
df
Sum of
Mean Square F
p
Square-:;
Knowledge
1
1.78
Error
75
97.1
TOTAL
76
98.88
1.78
1.38
.~4
1.29
To further establish if the variables. area, level designation, and experience had any
effect upon stated practice. a one-way analysis of variance was computed.
were significant, and indi\'idually the computed results showed:
area.
None
T.:~blc
lJ.
E(2,74); 0.03, p<.96, level; Table 10. E(2.74); 0.02. p<.98: and experience. Table
11, E(7,69) ; 0.88, p<. 52.
34
Table 9
One-way Analysis of Variance of Stated Practice by Area
Variable
df
Area
Sum of
Mean
Squares
Square
0.93
0.05
1.33
Error
74
98.79
TOTAL
76
98.88
F
p
0.03
.96
Table 10
One-way Analysis of Variance of Stated Practice by Nurse Lc\'cl
Variable
df
Le\'Ci
Sum of
Mean
Squares
Square
0.06
.03
1.33
Error
74
98.82
TOTAL
76
98.88
35
F
p
.02
.98
Table 11
One-way Analysis of Variance of Stated Practice by Experience
Variable
Experience
df
Sum of
Mean
Squares
Square
7
8.14
l.l6
Error
69
90.74
1.31
TOTAL
76
98.88
F
p
0.88
Question results in the opinion section revealed the following points of imcrcst. Of
those surveyed 37.47% agreed, 7.8% strongly agreed. that nursing has a low lc,·cl
of health hazard in the work place. Also 7'2.73% agreed, -+5.45% strongly agreed.
that in providing health care for others. nurses face a high personal risk factor.
Furthennore 55.74-% agreed. 38.04% strongly agreed. that it would be a waste oi
money to provide protective clothing in all patients' rooms. When wearing glo,·cs
66.23% agreed, ::!0.78% strongly agreed. that it made it awkward and difficult to
carry out procedures.
Of the nurses surveyed, 84.-1-'2% agreed. 70.13% strongly
agreed, that nurses me best protected by knowing the patient's diagnosis.
Finally
74% agreed, 42.86% strongly agreed, that putting on gloves. pbstic aprons. and
goggles as recommended was easy.
36
DISCUSSION
This study has revealed that although nurses may have a reasonable level of
knowledge and a positive opinion towards Universal Precautions, their stated
practice of the use of Universal Precautions may be low.
The nurses' level
designation of employment, area of work, and the length of clinical experience had
no significant effect on the level of stated practice. The results showed none of the
variables examined had any significant effect upon the low level of srmcd practice.
Findings must be viewed with caution because the instrument used to collect the
data was new and needs further resting for validity and reliubiliry. Baroff and Talan
(1989) and Kelen and Associates (1989) also found a low level of compliance to
Universal Precautions.
--
The merhodologv thcv used was observational and the
.
population different, but it would a.ppear that it is doubtful that health care workers
arc using recommended cross infection policies ro a high degree.
An examination of the results in relation to the specific study objectives reveal the
following points.
The usc of Universal Precaution principles as shown by the
subjects stated practice was low (M = 1.04, maximum possible score 7).
reflects a low level of stated compliance by the nurses in this study.
This
In their
conclusions Baroff and Talan (1989) commented that the un-acceptable rate of
compliance found in their study may have been partly due to the impression that
protective equipment was unavailable. The same comment could apply to this study
37
as protective attire was not visibly available in all areas. The major application of
Universal Precautions is to wear the appropriate protective attire when handling
blood and specified body fluids, and in situations where ocular and/or mucous
membrane exposure to splash or spray of body fluids is likely ro occur.
Yet the
availability of protective attire in visibly, and easily assessable places in all work
areas is not yet common practice. The time involved, and the perceived difficulty
of obtaining the appropriate protective attire, may indeed cause nurses not to stop to
implement Universal Precautions as recommended. If cross infection policy makers
expect health care workers to usc the recommended techniques to protect
themselves and other patients from nosocomial diseases, then the appropriate
equipment must be readily available in all work areas.
Many of the subjects had acquired a reasonable level of knowledge about Universal
Precautions (M = 6.97. maximum possible score 10).
The subjects level of
knowledge of Universal Precaution principles had no significant effect upon their
stated practice.
Nurses having an acceptable level of knowledge. about Universal
Precautions principles, did not always stme compliance in practice. Where subjects
obtained their knowledge from was unclear as relevant data was not collected. It
was assumed that the major source of knowledge was in-service education
programs offered by the hospital used in the study. It is of concern that nurses have
shown they have the necessary knowledge about the principles of Universal
Precautions yet are not stating they practice these principles
The knowledge
assessed in this study was about the principles involved in the :..tsc of Universal
38
Precautions.
Perhaps the subjects had a knowledge deficit in regards to the
significance of the development of Universal Precautions.
That is the fact that
Universal Precautions were developed because there was, and still is, no other
means of protecting health care works from contracting AIDS in the work place.
Universal Precautions guidelines developed from a decision by the C.D.C. in 1988
in response to the AIDS epidemic. Even so Universal Precautions is not promoted
as a specific means of protection against AIDS.
Zeidenstcin (1989) states 'The
primary pre-requisite for the implementation of Universal Precautions is acceptance
that we are practising in the midst of a deadly health crisis' (P. 282) lt may be that
nurses do not associate the use of Universal Precautions with the risk of comracting
AIDS.
To increase compliance educational programs developed for health care
workers may need to place more emphasis on the reasons for the de\'elopmcnt of
Universal Precautions, and the major personal health risk of not usmg Universal
Precautions.
Health care and hospital authorities do nor wish to cause fear and anxiety out of
proportion to the calculated assumed low occupational risk. However this must be
balanced against the need for improved c.rJmpliance in the usc of Universal
Precautions. At present the usc of Universal Precautions is the only known means
of protecting hospital staff against the risk, however small, of contracting a fatal
disease.
39
The p:>sitive opinion level (M = 43.51, maximum possible score 60) showed support
of cross infection principles, but this was not significant and showed no effect upon
the level of stated practice. Though the total mean scores showed positive support,
the subjects did not support the principle that represents the change of emphasis in
Infection Control on which Universal Principles is based,
namely isolming the
source of infection rather than isolating the diagnosed infectious patient.
In this
survey 84.42% of the subjects were of the opinion they were best protected by
knowing the patient's diagnosis. The principle of relying on the patient's diagnosis
as a means of knowing what precautions to take, in protection from cross infection,
is hard to change. For so long cross infection policy, until the advent of the AIDS
epidemic, was based on isolating the diagnosed infectious patient. This change in
cross infection emphasis of not relying on a patient's diagnosis and isolating the
source of infection, blood and certain body fluids. in Jll patients only occurred in
the 1980s.
This persisting belief that nurses arc best protected by knowing. the
patient's diagnosis may be influencing the Jack of usc of Universal
Prec~JUtions.
in
that nurses may have a feeling of false security in handling the blood and certain
body fluids of patienls who have not been diagnosed as having pathogens present in
these substances. It is the undiagnosed infection the patient may have that is the
potential health hazard and nurses need to change to believing that they :.1re best
protected in the work place by tre:ning all patients' blood :.1nd certain body fluids as
potentially infectious.
40
There was very little difference in the mean scores of stated practice in the three
area of work categories.
Area 1, high risk, had a mean score of 1.09, Area 2,
moderate risk, had a mean score of 1.00, and Area 3, low risk, had a mean score of
1.02.
Furthermore the computed analysis of the results showed that the assumed
risk level of nurses being exposed to splashing or spraying with patient's blood or
body fluids had no significant effect on the level of stated practice. Cross infection
experts, when making the Universal Precaution recommendations, used the terms
when at risk of splashing or spraying with blood or certain body fluids. The lack of
stated adherence to the Universal Precautions principles in areas that nurses are
regularly exposed to such substances, and assumed to be at a high risk level of
being splashed or sprayed with such substances, may be due to lack of associating
these substances as infectious unless the patient has been diagnosed as having
pathogens in their blood or certain body fluids.
This would support the lack of
change in the nurses belief system as demonstrated m their response of still
believing they are best protected by knowing the patients diagnosis, as discussed
previously.
The effect of the subjects' years of experience in direct patient care on stated
practice was computed as not significant. It was difficult to analyse the conflicting
results shown by the effect of each :angc of experience on stated practice. The five
nurses with more than six months, and less than three years experience, recorded a
stated practice mean score of 0.02, the lowest mean score. The seven nurses with
three years experience, but less than five years experience, recorded a stated
41
practice mean score of 1.71, the highest mean score. The 23 nurses with 20 years
and more experience recorded a stated practice mean score of 0.91, the second
lowest mean score. This may be indicating that the more experienced the nurse the
lower the stated practice will be, though such a statement must be viewed with
caution. Even so, these results may be suggesting that years of experience can affect
stated practice. In the total figures over 70% of the subjects involved in this study
had over 10 years experience in direct patient care. The results of this study can
therefore be viewed as coming from very experienced nurses.
The years of
experience may have affected the low level of stared practice because the years of
exposure to patients' blood and body fluids may have created a feeling of false
security in regards to the personal health threat from these substances which now
needs to be reversed by a change in the nurses belief system in line with Universal
Precaution principles of regarding all patiems' blood and certain body fluids as
potentially infectious. Remembering this change of cross infection principles only
occurred in the 1980s and the more experienced nurses would have been educated
in accordance with the Cross Infection principle of isolating the diagnosed
infectious patient rather than isolating all patients' blood and certain body fluids as
potentially infectious.
their belief system.
The practice of this principle would be well ingmined in
The less experienced nurses possibly received their nursing
education in the mid to late 1980s.
They may or may not have been taught the
change of emphasis in Cross Infection principles. If they had been taught to isolate
the diagnosed infectious patient rather than isolating all patients' blood and certain
body fluids as potentially infectious it would nor be as ingrained in their belief
system to the same extent as that of the more experienced nurses.
There was very little difference in the mean scores of the nurses in the three levels
of employment designation.
Level A, Enrolled Nurses, had a mean score of 1,
Level B, Level 1 Registered Nurses, had a mean score of 1.03, and Level C, Level
2 or 3 Registered Nurses had a mean score of 1.02. The computed analysis of the
results showed that the level of employment designation had no significant effect
upon the subjects stated practice.
Literature and educational material before the
early 1980s taught all level of nurses the belief system that special infectious
required special procedures and all levels of nurses were left with the belief that
routine patient care practices are inadequate to prevent transmission of infectious
diseases.
The use of Universal Precautions as recommended by cross infection
experts is a routine practice for all patients.
Of the points discussed in relation to the specific study objectives the nurses
established belief system may be the biggest hurdle to compliance of Universal
Precautions practice.
The nursing care management is basically still diagnosis
based, the conflict between the nurse wanting to know the patients' diagnosis and
the principles of Universal Precautions will need to be resolved. It will no doubt
take more time and further education to convince nurses they arc bc.st protected in
the work place by practising the principles Of Universal Precautions in treating all
patients' blood and certain body fluids as potentially infectious.
43
This study, though not conclusive, indicates that nurses' stated compliance to
Universal Precautions is low.
If this is so it means nurses are not following
recommended techniques of preventing cross infection.
There are many possible
factors which may affect this lack of stated compliance and there is a need for
further research to examine this question of recommended nosocomial disease
protection.
44
RECOMMENDATIONS
1.
To further study the factors that may influence nurses' usc of Universal
Precautions.
2.
Re-enforce, by repeated education of staff, the change of cross infection
principle involved in Universal Precautions of treating blood and certain body
fluids of all patients as potentially infectious.
3.
To make protective attire more visibly and easily available and accessible in all
areas of the work place.
45
References
Adler, M.W. (Ed.). (1988). ABC of AIDS. London: Published by the British Medical
Journal.
AIDS: A time to care a time to act. (1988). Canberra: Australian Government
Publishing Service.
AIDS prevention and control: Invited presentations and papers from the world summit
of ministers of health on programmes for AIDS preveorjon. (1988). Geneva: World
Health Organisation Oxford: Pergaman Press. joimly.
Baroff, L.J. & Talan. D.A. (1989).
Compliance with universal precautions in a
university hospital emergency department. Annals of Emergency Medis:ine. lli(6),
654-7.
Brass, A., & Gold, J. (1985). AIDS and Australia. Sydney: Bay Books.
Connor, S. & Kingman, S. (1988). The Search for the Vjrus. London: Penguin Books.
Cook, I.F. (Ed.). (1988). Universal precautions for HIV. HBV. and other bluodburne
pathogens. Communicable Diseases Intelligence. Sft(l-1-), 6-12.
Doken. L., Beiningen, G. & Vander Woude. D. (1989. May). An evaluation tool for
monitoring compliance with BS1. Papers Accepted for Prt!Sentatjon at APIC '89:
Sixteenth Annual Educational Conference Reno. Nevada. pp. 104. {Abstracts Oral
Presentations).
Fekety, S.E. (1989). Managing the HIV-positive patit!Dt and the newborn
10
a CNM
service. Journal Qf Nurse Mjdwjferv, J:±, 253-25H.
Hicks, R. (1990, March 31). Health workers and AIDS: a waiting game. Iru:.
Australian, pp.16.
46
Hollick, G.E. (1989). Universal precautions vs. body substance isolation.
Cliojcal
Microbiology Newsletter, ll(10), 76-77.
Kelen, G.D., Di Giovanna, T., Bisson, L., Kalaino, D., Siverton, K.T., & Quinn, T.C.
(1989).
Human immunodeficiency virus infection in emergency department
patients.
Epidemiology clinical presentation. and risk to health care workers: The
John Hopkins Experience. Journal of American Medical Association, 26,2, 516-22.
(From Medline, abstract no. 89294059)
Lynch, P., Jackson, M.M., Cummings, M.J., & Stamm. W.E. (1987). Rethinking the
role of isolation practices in the prevention of nosocomial infections. Annals of
Internal Medicine, 101. 243-246.
Morbidity and Mortality Wet!kly Report. (198t!). Update: Umvcmd pn:cauljoos for
prevention of transmjssion of human immunodeficiency vjrus. ht:pi!titis 8 vuus,
and other bloodbome pathogens jn health-care settjng'j, 31. 377-389.
National HIV/AIDS strategy. (1989). Canberra: Australian Government Publishing
Service.
Nonnhold, P. (1990). 90 predictions for the 90s. Nursing 90
~ (1 ),
3-1---1-1.
Valenti, W.M. (1988). From ritual to reason and back again: OSHA and the evolution
of infection control. Infection Control Hospital Epidemiology, 2. 289-290.
Waltz, C.F., Strickland, O.L.. & Lenz, E.R. (198-i-). Measurement jn nursing research
Philadelphia: F.A. Davis Company.
Whipple. B., & Scura, K.W. (1989). HIV and the older adult taking the necessary
precautions. Gerontological Nursing,
U. 15-19.
Zeidenstein, L. (1989). Adapting universal precautions in a CNM service. Journal of
Nurse Midwifery, .3_±, 280-283.
47
APPENDIX A
QUESTIONNAIRE
Protection of Nursing Staff Survey
Imagine yourself in the following real life scent!s.
What would you do in each situation in order to protect yoursdf in a cost effective:
manner.
1.
An eldt:rly man with Parkinsons disease and dementia. after using a urinal spills
the urine in his bed. You go to change the bed lint!n.
What action do you take BEFORE you attt:nd to the patient.
Circle your answer or answers.
A.
B.
C.
D.
E.
F.
2.
No action
or
The followmg c:m be more than unt' acuen.
Put on goggles
Put on gloves
Firs! wash hands
Put un a plastic apron
Put on a mask
A middle aged woman is admined with a hiswry of a gastric ulcer and vomiting
coffee ground coloured fluid. You answer her call bell and find her vomiting frank
blood. You go ro her assistance.
What action do you take BEFORE you altend to
th~;:
patient.
Circle your answer or answers.
A.
B.
C.
0.
E.
F.
No acuon
or
The following can be more than one action.
Put on goggles
Put on gloves
First wash hands
Put on a plastic apron
Put on a mask
3.
A young woman with a crushed right hand is admitted to hospital. She continues
to breast feed her three week old baby, who has been admitted with her. She
requests your assistance to express some milk.
What action do you take, BEFORE you attend to the patient.
Circle your answer or answers.
A.
No action
8.
C.
D.
or
The following can be more than one action
Put on goggles
Put on gloves
First wash your hands
Put on a plastic apron
Put on a mask
E.
F.
4.
.-\ young male recovering from a head injury requires feeding at :neal times. His
past medical history includes a positive HIV blood itsi. He is quiet and c.Joperative and you go to feed him at lunch ;6-le.
What action do
~·au
take BEFORE ;·au .:m:=:J.d
tO
;he ?Zt1e:1t.
Circle your answe: or answe:s.
A.
8.
C.
D.
E.
F.
~o action
or
The following c.1n be more than one ac:ion
Put on goggle~
Put un gloves
First wash your hands
Put on a p!astic <~prun
Put on a mask
5.
A middle aged woman, one day post operation following a cholecystectomy has
developed a productive cough. Sht: n:quirt:s a lot of assistance and encouragement
to deep bremh and cough. To obtain a sputum specimen you an: going to assist
her to cough.
What action do you take BEFORE you attend to the patient.
Circle your answer or answers.
A.
No action
or
B.
C.
D.
E.
F.
6.
The following can be more than one i.lt:l!un.
Put un goggles
Put on gloves
First wash your hands
Put on a plasric apron
Put on a mask
:J haemorrhotdectom~ ha~ JUSt g.une back to bed
havmg ht~ bowels opened. He t.:alls yuu over dnJ ::.ay~ he thu::;.~ he ha~ naJ .=
!urther bowel action m the bed. You ensure pnvacy and pull b<d:. the bed line:1
.md se:: a large pool of blood and faeces.
.-\n dderly man recovenng from
:.~iter
\Vhat acuon do
~·ou
tak.: BEFORE you :mend to the pattem.
Circle your answer ur answers.
A.
No action
or
B.
C.
D.
E.
F.
The following can be more than une J.:llun.
Put on gogglr.:s
Pm on gloves
First wash your hands
Put on J plastic apron
Put on a mask
7.
The maternity unit is very busy and you havt: been asked 10 give.! a Oc.!W hum baby its fina
bath. The motht:r is wt:ll but sedated. The bahy is physically normal ant.l in nu Jistrcss.
What action do you take BEFORE you ant:nd to tht:' baby.
Circle your answer or answers.
A.
B.
C.
D.
E.
F.
No action
or
The following can be more than one action.
Put on goggles
Put on gloves
First wash your hands
Put on a plastic apron
Put on a mask
WHAT IS YOUR OPINION OF THE FOLLOWING STATEMENTS:
R<\TE THEM ON A SCALE OF 1 TO 6
CIRCLE THE APPROPRIATE NUMBER
STATEMENT
I.
Nursing, when compared to other
occupations, has a low levd of
health hazard in the work place
2.
Strongly Agree 1
Nurses are best pratet.:ted by
,
3
4
5 6 Strongly Disagree
,
3
4
5 6 Strongly Disagree
,
3
4
5 6 Strongly Disagree
,
3
4
,
,
3
4
5 6 Strongly Disagree
,
3
~
5 6 Stl·ongly Disagree
knowing the patients' diagnosis
3.
-1.
of any infectious dis!.!JSe.
Strongly Agree 1
Using gloves means you don't
have to wash your hands 35 often.
Strongly Agree 1
It would be cost dfective. and
create no risk. if tht: nurse
won: the same pau of gloves for
5.
several patients as ne::ded.
Strongly Agree 1
Wearing gloves makes 11 awkward
6 Strongly Disagree
and difficult to carry out
procedures.
6.
Strongly Agree 1
A nurse's best protecuon from
infection is .:m intact skm.
'·
S.
9.
10.
Strongly
It is easy to put on glu\·es.
plastic apron. and guggks
as recommended.
Strongly
In providing health ..:are rur
orhers. nurses face J h1gh
personal risk factor
Strongly
Making plastic glo\"eS. ~oggl::s.
masks and plastic aprons
available in !!very parienrs
room is a waste of money.
Strongly
Tht: best protection from cross
infection is hand washln!,! Jfter
patient contact.
Strongly
.-\gree 1
.-\gree I
-,
3
4
5 6 Strongly Disagree
.-\gree I
'
3
~
5 6 Strongly Disagree
Agree 1
'
3
4
5 6 Strongly Dis:1gree
Agree 1
'
3
4
5 6 Strongly Disagree
CIRCLE THE APPROPRIATE ANSWER: (one answer only I
1.
Plastic gloves should be worn:
a.
b.
c.
d.
when
when
when
all of
handling blood. tissue and body fluids of all patients.
both your hands are affected by dermatitis.
handling blood. tissue and body fluids of a patit!nt with a diagnosed infection.
the above.
Plastic aprons should be worn:
b.
c.
When you may be splashed with body flu1ds.
When you have a cut on your abdomen.
All of the abo\'e.
Goggles and masks should be worn:
a.
b.
c.
d.
When you ha\'t: an infected eye.
When you may be sprayed with hody
When you do a mouth toilet.
All of the above.
Which of
a.
b.
c.
d.
5.
th~
fluid~.
fol\owmg constimtes a "significant exposun;
Blood splash to mouth. nose. c:yes, or an open skin lt:s10n.
Needles1ick with a sterile ne::dlt:.
Momh-to-mouth resuscimuon.
All of the above.
Patients with infections that spn:ad through only blood nr buJy flu1ds:
a.
b.
c.
d.
6.
your uniform twice heforc it is washed.
When you need to
d.
3.
w~:ar
a.
Will always have the diagnosts written m the notes.
Will be adequately isolated if routine procedures of blood and body fluids precautions
are carried >..~Ut.
Will most often have obvious symptoms and be identifiable by climcal assessmem.
All of the abovt:.
Overwearing of gloves when not indicated may result in:
a.
b.
c.
d.
lncrease\.1 contamination of the environment.
Increased risk of cross-infection to patients.
Increased risk to employe:: hand irritation/dermatitis.
All of the above.
7
Hand washing is now considered:
a.
b.
c.
d.
8.
To maintain your skin protection you should:
a.
b.
c.
d.
9.
Frequently use a moisturiser
Cover cuts with a waterproof sealed dressing.
Wear gloves if you have chaffed hands.
All of the above.
Used needles should always:
a.
b.
c.
d.
10.
To be replaced by using gloves when handling blood and body fluids.
To be the most imponant means of preventing cross infection.
Not necessary if gloves have been worn.
None of the above.
Be recapped and plac~d 111 a waterproof hag pnor to d1sposal.
Be recapped. earned 111 a com<~iner. <~nd dispos~.:d of 111 a sharp~ comaincr.
Not be recapped. carried in a contamer. and disposed oi 1n a sharps contained.
N01 be: recapped. earned in the h:md. and disposed of 111 a sharps container.
Last night you cut yourself on the middle finger of your lett hand. Th1s mommg thc cut 1s
dry. What should you do when you arnve at work:
a.
b.
c.
'--'·
Place a band-aid over the cut.
Leave the cut expost:d.
Put on a plastic glove.
Put a waterproof. sealed dre:ssing over
th~:
em.
APPENDLX B
DEMOGRAPHIC DATA
Please tick the appropriate answer:
Category of employment designation:
Enrolled Nurst!
................................................................................... [ J
Registered Nurse Levd One ........................................................................ [ J
Clinical Registered Nurse Level Tw.o ............................................................ [ ]
.A.re you currently involved in direct 'hands on' patient care?
Yes
................................. [
No
•••••••••••••••u•[
Experience:
How many yearstmunths experience ot din:ct patient can:'!
UNDER 6 months
••••••••u•••••••••••••••••••l
I
6 months and O\"er/Bt;T under a ye3r.......... .
········ ...... [ I
1 ye:~.r and over including 2 years ................ .
• • • •••
u•u•
I I
3 years and over including 5 years ............................................................... [ J
6 years and over including 9 years ............................................................... [ ]
10 years and over including 14 years ............................................................ [ ]
15 years and over including 19 years ..
.. ... ......
.... ·I I
20 years and over
............ .
........ [ I
What type of nursing are you CL'RRE!\TL Y INVOLVED I.!"\1'.1
Ple3Se tick the ONE you spend the MOST time being involved
10 ·-
Operating Room
.................................................................................. [ l
Maternity
.................................................................................... [ ]
Geriatrics
.................................................................................. [ ]
General Medit:~J! :md Surg.IL:al
.....................
............................... [ ]
If not listed. please State
...................................................................... [ l
APPENDIX C
PROTECTION OF NURSING STAFF SURVEY
Dear Colleague
I am inviting you to take part in a survey I am conducting for the degree of Bachelor of
Health Sd!!nce (Nursing) Honours program at the Western Australian College of
Advanced Education.
The purpose of this study is to examine how you, as nurses, protect yourselves when
involved in direct patient care.
To protect your identity no names will be recorded, and no record will be kept of the
day, the time or the group, from which the completed questionnaires come.
I alone
shall be the recorder of data from the completed questionnaires. which shall be
destroyed at the conclusion of the study.
Your participation is purely voluntary, ;:md you will not be discriminated against for not
being involved. You may leave the group at any time.
It is very important to answer all questions exactly as you feel about them. because the
infonnation gained from you who are involved in direct 'hands on' patient cart! is vital
and could be used in determining future m::cds and possible policy reviews.
At the completion of the study a verbal and wrilll!n report of the results will be
presented to each unit that participated in tht! data collection.
be arranged with the hospital.
Thank you for participating in the survey.
Yours sincerely
ROBIN JACKSON
R.N.
48
a1
an appropriate time to